Apparatus for delivering energy within continuous outline

ABSTRACT

An apparatus is provided for delivering energy to a selected area on a surface. The apparatus includes an outlining mechanism which receives light from a light source and directs an aiming beam to a surface, an energy source direction modulator which receives energy from an energy source and directs the energy to the surface, and a controller which causes the outlining mechanism to move the aiming beam relative to the surface to form a visually continuous outline around an area of the surface and causes the energy source direction modulator to deliver energy within the area formed by the visually continuous outline. The apparatus can also include an operator selectable activation mechanism which the apparatus requires to be continuously activated in order to deliver energy.

BACKGROUND OF THE INVENTION

1. Field of the Invention

The present invention relates to a method and apparatus for deliveringenergy to a surface. More specifically, the present invention relates toa method and apparatus involving the formation of a visually continuousoutline around an area of a surface within which energy is to bedelivered.

2. Description of Related Art

A wide variety of skin abnormalities exist for which treatment iscommonly sought to remove the abnormality. Examples of such skinconditions include dermatologic acne, scars (most commonly due to acne),xanthomas, and unwanted skin discoloration. Examples of skindiscolorations include freckles, age or liver spots, birthmarks,malignant melanomas, nevi (melanocytic, epidermal, vascular, andconnective tissue), lentigines (brown spots on the skin or mucousmembrane) and tatoos. In addition, discoloring abnormalities may be dueto vascular lesions which are caused by an abundance of enlarged bloodvessels. Common examples of discolorful vascular lesions are "port wine"stain birth marks, telangiectasis, a colored spot formed most commonlyon the skin by a dilated capillary or other small blood vessel, andhemangioma, a highly visible benign tumor composed of well-formed bloodvessels and classified as capillary or cavernous.

A variety of methodologies have been developed for treating skinabnormalities including, for example surgical excision, skin grafting,dermabrasion, saliabrasion, cryosurgery and laser surgery. One class ofthese methodologies involves the treatment of skin with an energysource, most commonly a laser or an RF electrode which causes thermaldamage or necrosis to the skin.

A major problem associated with the treatment methods involving thedelivery of energy to the skin to cause thermal damage or necrosis iscontrolling where energy is being delivered to the skin as well as theamount of energy that is delivered to particular areas of the skin. Aneed therefore exists for a method and device for delivering energy tothe skin which provides the user of the method and/or device with theability to control where energy is delivered to the skin and how much.At the same time, the method and device should be easy for the user touse so that the skin can be treated safely, accurately, rapidly andeconomically. These and other objectives are provided by the device andmethod of the present invention which is described herein.

SUMMARY OF THE INVENTION

An apparatus is provided for delivering energy to a selected area on asurface. The apparatus includes an outlining mechanism which receiveslight from a light source and directs an aiming beam to a surface, anenergy source direction modulator which receives energy from an energysource and directs the energy to the surface, and a controller whichcauses the outlining mechanism to move the aiming beam relative to thesurface to form a visually continuous outline around an area of thesurface and causes the energy source direction modulator to deliverenergy within the area formed by the visually continuous outline. In oneembodiment, the apparatus includes an operator selectable activationmechanism. In this embodiment, continuous activation of the activationmechanism is required in order to deliver energy.

A hand held dermoablation apparatus is also provided which includes ahandpiece, a distal end for resting the apparatus against a skin of apatient, an outlining mechanism which receives light from a light sourceand directs an aiming beam to the patient's skin, an energy sourcedirection modulator which receives energy from an energy source anddirects the energy to the patient's skin, and a controller which causesthe outlining mechanism to move the aiming beam relative to thepatient's skin to form a visually continuous outline around an area ofthe patient's skin and causes the energy source direction modulator todeliver energy within the area formed by the visually continuousoutline.

A method is also provided for delivering energy to a selected area of asurface. According to the method, a visually continuous outline isformed on the surface. The visually continuous outline is positioned onthe surface such that the outline surrounds an area to be treated withenergy. Energy is then delivered within the area surrounded by thevisually continuous outline.

A method is also provided for delivering energy to a selected area of asurface which includes the step of activating an activation mechanismwhich causes energy to be delivered within the area surrounded by thevisually continuous outline. According to this method, continuousactivation of the activation mechanism is required in order to deliverenergy.

A method is also provided for ablating selected areas of skin on apatient. According to the method, a visually continuous outline isformed on a patient's skin. The visually continuous outline ispositioned such that the outline surrounds an area of skin to beablated. Energy is then delivered to the area of skin surrounded by thevisually continuous outline.

In the apparatus and methods of the present invention, the visuallycontinuous outline can have a plurality of shapes including polygons(square, diamond, rectangle, triangle, pentagon, hexagon, heptagon, andoctagon), circles and ellipses. These shapes can be predetermined by theapparatus or programmed into the apparatus by the operator. The visuallycontinuous outline can also have a plurality of sizes which can bepredetermined by the apparatus or fully adjustable within a size range.

The apparatus and method may be used to perform a variety of medicalprocedures. For example, the apparatus and method can be used to ablatea surface layer of skin, preferably less than about 0.05 mm thick, morepreferably less than about 0.03 mm thick. Energy can also be directed tothe surface in a pattern adapted for performing dermoablation, forremoving hair from an area of skin or for creating holes in skin intowhich hair follicles can be implanted.

The controller used in the apparatus preferably includes a feedbacksystem for controlling the outlining mechanism, energy source directionmodulator as well as how and when energy is delivered. For example, thefeedback system can be used to disable the delivery of energy when anerror in an operation of the outlining mechanism or energy sourcedirection modulator is detected by the feedback system. The feedbacksystem can be used to produce an error signal when an error in anoperation of the outlining mechanism or energy source directionmodulator is detected by the feedback system. The controller can alsoinclude software for controlling the size, shape and placement of theaiming beam and energy, the software being stored as RAM data and as ROMdata. The feedback system can be used to compare the RAM data to the ROMdata prior to operation of the apparatus and disable the delivery ofenergy if the RAM data does not match the ROM data. The feedback systemcan also monitor the amount of power delivered to the apparatus anddisable the delivery of energy when the amount of power delivered to theapparatus falls below a predetermined level.

BRIEF DESCRIPTION OF THE FIGURES

FIG. 1 illustrates an apparatus according to the present invention.

FIG. 2 illustrates a typical scanning motion geometry for a hexagonalarea.

FIG. 3 illustrates a schematic for an embodiment of a controller systemwhich may be used in an apparatus of the present invention.

FIGS. 4A-C illustrate a method for treating a surface with energyaccording to the present invention.

FIG. 4A illustrates the step of directing an aiming beam to a surfacesuch that the aiming beam forms a visually continuous outline around anarea of the surface.

FIG. 4B illustrates the step of treating the outlined area with energywhere the visually continuous outline is not produced while energy isdirected to the surface.

FIG. 4C illustrates the step of treating the outlined area with energywhere the visually continuous outline is produced while energy isdirected to the surface.

FIG. 5 illustrates energy being distributed substantially uniformly overan area of a surface.

FIG. 6 illustrates energy being distributed in desired pattern within anoutlined area.

FIGS. 7A-7B illustrate a method for performing dermoablation accordingto the present invention.

FIG. 7A illustrates an area of skin outlined on a patient's face.

FIG. 7B illustrates the ablation of the area of skin outlined in FIG.7A.

FIGS. 8A-D illustrate a method for removing hair according to thepresent invention.

FIG. 8A illustrates an outlined area of skin containing hair follicles.

FIG. 8B illustrates the ablation of the area of skin outlined in FIG.8A.

FIG. 8C illustrates skin which has been treated repeated times to form acontinuous mosaic of adjacent energy treated areas.

FIG. 8D illustrates the step of extending the continuous mosaic ofadjacent energy treated areas by ablating the area outlined in FIG. 8C.

FIGS. 9A-E illustrates a method for implanting hair according to thepresent invention.

FIG. 9A illustrates outlining an area of skin.

FIG. 9B illustrates the ablation of the area of skin outlined in FIG.9A.

FIG. 9C illustrates hair follicles being implanted into the ablatedareas shown in FIG. 9B.

FIG. 9D illustrates skin which has been treated repeated times to form acontinuous mosaic of adjacent energy treated areas.

FIG. 9E illustrates the step of extending the continuous mosaic ofadjacent energy treated areas by ablating the area outlined in FIG. 9D.

FIG. 10 illustrates an apparatus according to the present inventionwherein the energy source is an Rf electrode.

DETAILED DESCRIPTION

The present invention relates to a method and apparatus for deliveringenergy to a selected area on a surface where a visually continuousoutline is formed around the selected area. This visually continuousoutline identifies to the operator of the apparatus an area within whichenergy will be delivered. By forming a visually continuous outlinearound the selected area prior to delivering energy, the operator isable to accurately visually identify the area of the surface to whichenergy will be delivered before the energy is delivered. By being ableto visualize the area that will be treated prior to the delivery ofenergy, the safety and accuracy of the method and apparatus is improvedas compared to previous methods and devices.

A further aspect of the method and apparatus relates to the inclusion ofan operator selectable activation mechanism which requires continuousactivation by the operator in order to deliver energy. By requiringcontinuous activation for energy to be delivered, the operator is ableto discontinue the delivery of energy by merely releasing the activationmechanism. As a result, the operator has a rapid and simple mechanism bywhich to stop the delivery of energy, thereby further improving thesafety of the method and apparatus.

In general, the apparatus may be used to deliver energy to any surface,including surfaces which need to be exposed prior to the delivery ofenergy. Examples of surfaces that may be treated with energy using themethod and apparatus of the present invention include, but are notlimited to skin, an exposed area of internal tissue such as muscle orfat tissue, and a surface in an oral cavity such as gum tissue or atooth enamel. Examples of particular applications to which the methodand apparatus may be applied include, but are not limited to skinsurface ablation, hair removal, hair implantation, gum ablation anddisinfection, tooth enamel cleaning, fat tissue ablation for breastreduction, evaporation of severely burned tissue, drilling a hole inheart muscle, heating tissue for pain reduction, and the ablation oftumors within the body.

This invention is particularly important for use in applications whereone needs to carefully control the area of a surface to which energy isapplied. One such class of applications are dermatology proceduresinvolving the treatment of selected areas of the skin with energy.Accordingly, the present invention is intended to encompass all forms ofdermatology methods and apparatuses which include the application ofenergy to a desired area of skin. For example, energy may be used toablate an upper layer of the skin (dermoablation), to remove hair fromthe skin, or to create holes within the skin into which hair folliclesmay be implanted. In these and other dermatology procedures, it isimportant that the location on the skin where energy is delivered becarefully controlled. Otherwise, unwanted damage can occur due to anarea of tissue being exposed to energy that should not be treated (e.g.,the eye) or due to an area being treated with too much energy, therebycausing scarring.

One embodiment of the invention is illustrated in FIG. 1. In thisembodiment, the apparatus 12 includes a handpiece 13, an external lightsource 14 used to produce an aiming beam 16, a light conduit 15 forconveying light from the external light source 14 to the handpiece 13,an outlining mechanism 18 for moving the aiming beam 16 relative to asurface 22 to form a visually continuous outline 20 around an area 24 ofthe surface 22, an external energy source 26, an energy conduit 27 forconveying energy from the external energy source 26 to the handpiece 13,and an energy source direction modulator 30 which directs energy 28 fromthe handpiece 13 to different locations within the area 24 outlined onthe surface 22.

The handpiece 13 is used by the operator to adjust the position of thevisually continuous outline 20 on the surface 22 and hence where energyis delivered on the surface. The handpiece 13 may also include a distalend 23 which the operator positions against the surface, the distal endassisting in the operator's positioning of the visually continuousoutline 20. When light energy is used, the light energy can be focusedat a distance adjacent the distal end 23 of the handpiece 13.

Also included in the apparatus 12 is a controller 31 which is connectedto the outlining mechanism 18, the light source 14, the energy source 26and the energy source direction modulator 30. The controller 31 can beused to control the shape of the outline formed by the outliningmechanism 18. The controller 31 can also be used to control the energysource direction modulator 30 so that energy is delivered within area 24outlined on the surface 22.

The controller 31 is preferably designed to operate the outliningmechanism 18 and energy source direction modulator 30 under feedbackcontrol, i.e., where the actual position of the aiming beam and/orenergy is detected and fed back to the controller which adjusts theoperation of the outlining mechanism 18 and energy source directionmodulator 30 in response. If a predetermined error in the position ofthe aiming beam and/or energy is exceeded, the controller can bedesigned to interrupt the operation of the apparatus. The apparatus canalso include a mechanism for providing the operator with an audible orvisible signal that an error has occurred. In one embodiment of thecontroller, software used to control the size, shape and placement ofthe aiming beam and energy is stored in RAM, a non-volatile memorydevice and is redundantly stored in erasable ROM. The controllercompares the RAM data to the ROM data prior to operation. If the ROM andRAM data do not match, the controller prevents the operation of theapparatus and signals the existence of a software error to the operator.

The controller 31 can also be used to control when and how energy isdelivered to the surface. For example, the controller 31 can controlenergy intensity, spot size, and the scan speed of the energy sourcedirection modulator 30. The controller 31 can also control whetherenergy is delivered in a continuous or pulsed manner. When pulses ofenergy is used, the controller can also be used to control the durationof each pulse.

The controller can also be used to monitor the amount of power beingsupplied to the apparatus. Low power can interfere with the properoperation of data processing operations in the apparatus. As a safetyfeature, the controller can be designed to discontinue the delivery ofenergy when power to the apparatus drops below a predetermined minimumacceptable level. The apparatus can also include a mechanism forproviding the operator with an audible or visible signal that the powerhas dropped below the minimum acceptable level.

The controller preferably includes a microprocessor for performing theabove-described operation. The use of a microprocessor providesincreased control, precise placement, and homogeneous application ofenergy to the surface. Because of the normally tedious nature ofapplying single spot laser energy over large areas, a microprocessorcontrolled scanning system improves the safety of the device bydecreasing fatigue experienced by the physician during a procedure. Thehigh bandwidth design of the system offers scanner capabilitiespreviously unavailable in any application other than CO₂ soft tissue,extending the safety and effectiveness improvements to a broader rangeof procedures.

As also illustrated in FIG. 1, the apparatus includes an operatorselectable activation mechanism 33 which the operator activates in orderto cause energy to be delivered from the apparatus. The operatorselectable activation mechanism 33 is illustrated in FIG. 1 as afootswitch which the operator steps on to activate the apparatus.However, it should be understood that the operator selectable activationmechanism 33 can be incorporated into the apparatus in any manner bywhich the operator selectable activation mechanism 33 can beconveniently operated. For example, when the apparatus includes ahandpiece 13, the operator selectable activation mechanism 33 can beincorporated onto the handpiece 13, for example, as a depressiblebutton.

The operator selectable activation mechanism 33 is preferably designedto require continuous activation by the operator in order to deliverenergy. For example, as illustrated in FIG. 1, the operator selectableactivation mechanism 33 can be a footswitch which must be continuouslydepressed in order for energy to be delivered, release of the footswitchcausing the delivery of energy to be discontinued.

The operator selectable activation mechanism 33 is preferably connectedin series between the energy source 26 and the handpiece 13 such thatenergy is only delivered from the handpiece 13 when the activationmechanism 33 is being continuously activated by the operator. Byrequiring continuous activation, delivery of energy can be interruptedsimply by discontinuing activation (e.g., letting go of a button orfootswitch) as opposed to having to activate another mechanism (e.g.,pressing a button) to deactivate the apparatus. This greatly increasesthe safety of the device by simplifying the system by which the deliveryof energy is discontinued.

A schematic illustrating an embodiment of controller system including anoperator selectable activation mechanism 33 is illustrated in FIG. 3. Inthis embodiment, initial activation of the activation mechanism 33serves to signal the controller 31 to initiate delivery of energy to thesurface. When activated, the activation mechanism 33 forms a linkbetween the energy source 26 and the handpiece 13 to allow energy topass therethrough. When initially activated, the energy source directionmodulator 30 is instructed to move at the appropriate step increment andfrequency, rastering in X and Y axes, until the pattern defined by theaiming beam is filled in by treatment spots or emission. FIG. 2illustrates a typical scanning motion geometry for a hexagonal area witha start point 35 and an end point 37. Once a scan is completed, thecontroller 31 disables the delivery of energy regardless of whether theactivation mechanism 33 is activated. Depending on the mode of operationselected, the operator will either have to release the activationmechanism before pressing it again to initiate another scan cycle(single pass mode), or continue to hold the activation mechanism closedand wait for a predetermined period of time for another scan cycle toinitiate (repeat mode).

In one embodiment, the apparatus is capable of producing a plurality ofdifferent outline area shapes and sizes. The apparatus is preferablycapable of producing outlines of at least three different shapes and ofat least three different sizes for a particular shape. According to thisembodiment, the controller directs the outlining mechanism to produceone of the plurality of different outline area shapes and sizes. Thecontroller also directs the energy source direction modulator to deliverenergy within the outlined area. Hence, when a different outlined areasize or shape is selected, the controller causes the energy sourcedirection modulator to direct energy within the selected outlined area.

FIGS. 4A-C illustrate a method according to the present invention fordelivering energy to a surface within an area identified by a visuallycontinuous outline. According to a first step of the method, illustratedin FIG. 4A, an aiming beam 16 is directed to a surface 22 such that theaiming beam 16 forms a visually continuous outline 20 around an area 24of the surface 22. The particular size and shape of the visuallycontinuous outline that is formed is preferably selectable by theoperator. Then, by adjusting the position of the visually continuousoutline 20 on the surface 22 so that the outline surrounds an area 36 ofthe surface 22 which the operator wishes to treat with energy, theoperator can selectively deliver energy to the desired area 36. Thevisually continuous outline 20 thus serves as a guide which clearlyidentifies to the operator where energy from the energy source will bedelivered on the surface and enables the operator to accurately controlthe position of energy delivery.

Once the visually continuous outline 20 is positioned in the desiredlocation on the surface, energy 28 is directed to the surface 22. In oneembodiment, illustrated in FIG. 4B, the visually continuous outline 20is not produced while energy 28 is directed to the surface 20.Alternatively, as illustrated in FIG. 4C, the visually continuousoutline 20 is produced while energy 28 is directed to the surface 20. Itis also envisioned that partial or intermittent outlines alternately maybe formed while energy is directed to the surface.

The visually continuous outline used in the method and apparatus of theinvention may be formed by a light source which forms an aiming beam andan outlining mechanism which moves the direction of the aiming beam suchthat the perimeter of an area on a surface appears to be continuouslyilluminated. As used in this application, the term "visually continuousoutline" is intended to encompass any illumination of a perimeter of anarea such that the perimeter appears to be illuminated at the same timeto the naked eye. By illuminating the perimeter of the area to betreated, the user can directly visualize the area to be treated withouthaving to approximate. The perimeter is preferably illuminated by acontinuous line. However, the perimeter may also be illuminated by aseries of spots and/or lines which surround the area.

The light source used to form the aiming beam may be any light sourcewhich produces a beam of light which can be sufficiently focused to forma visually continuous outline on a surface. It is generally preferredthat a collimated light source such as a laser be used to form theaiming beam in view of the narrow beam diameters that can be generated.In one embodiment, the light source used to form the aiming beam is alsoused as the energy source. In one embodiment, the light source used toform the aiming beam also includes a mechanism which adjusts thediameter of the beam forming the outline on the surface.

According to the present invention, the outlining mechanism is used toadjust the direction of the aiming beam relative to the surface in orderto form an outline around an area on the surface. In general, an outlineis formed by causing a scanner to move a laser beam with a visible lightemission repeatedly along a path at a frequency greater than can bediscerned by the human eye, for example 30-50 times per second. As aresult, the entire path appears to be continuously illuminated.

Methods for forming a visually continuous outline using a scanner andlight source are known in the art. One approach is to divide an outlinepath into a series of points. Galvanometric motors can be used to movethe light source from point to point in a continuous cycle. Thegalvanometric motors are preferably free-floating (no-springs) and arepreferably operated under feedback control by the controller, allowingfor very high bandwidths.

In one embodiment of the invention, the apparatus can produce outlinesof one or more predetermined shapes including polygons (e.g., square,diamond, rectangle, triangle, pentagon, hexagon, octagon, circles andellipses). The apparatus may also be designed so that the size of thearea outlined is fully adjustable within a particular area size range.Accordingly, one embodiment of the method of the present inventionincludes the step of selecting one of the predetermined sizes and shapesfor the visually continuous outline. In one embodiment, the outlinedarea has a size between about 9 mm² and 2500 mm².

The apparatus may also be programmable such that the operator caninstruct the outlining mechanism as to the shape of the area aroundwhich the outline is to be formed. The ability to program the outlinemechanism to provide a desired outlining pattern is particularly usefulfor the removal of skin tumors, tatoos and the treatment of other areaswhere the shape of the area to be treated varies on a case by case basisand where it is important to accurately control the treatment area.Programming the desired outlining pattern into the apparatus can beperformed by a variety of methods known in the art. For example, theoperator can employ a JoyStick to draw an outline which can be savedinto memory. Alternatively, a computer mouse can be used to design anoutlining pattern.

A variety of different forms of energy may be used with the method andapparatus of the present invention. Examples of such forms of energyinclude, but are not limited to electromagnetic energy, such as visiblelight, ultraviolet light, RF energy, microwaves and ultrasonic energyand thermal energy. When the energy source is visible light, the lightmay be coherent or non-coherent light. Coherent light is generallypreferred because it is more reproducible and enables the energy sourceto be controlled more precisely. Examples of coherent light sourcesinclude lasers, such as excimer (351 nm), argon (488, 514 nm), Frequencydoubled YAG (532 nm), ruby (694 nm), Nd:Yag (1060 nm), and CO₂ (10,600nm) lasers.

When the energy source is a laser light source, the apparatus can beadapted to be used with multiple wavelengths of light. For example, theapparatus may be designed to be readily converted for use with differentwavelengths by changing any wavelength specific reflectors and/ortransmissive optics employed in the apparatus.

Collimating and focusing optics may be incorporated into the apparatusas is necessary to achieve laser light spots of a desired size andintensity. In one embodiment, the laser energy spots formed by theapparatus have a diameter between about 200 μm and 5 mm.

The form of energy used in a particular method or apparatus according tothe present invention depends on the surface to be treated and the typeand amount of energy which is needed to treat the particular surface.The form of energy used should also be focusable within the outlinedarea with the desired degree of accuracy. In some cases, it may benecessary for the energy to be focused onto a very small area, forexample, in order to remove individual hair follicles. In other cases,it may be acceptable for the energy to be less focused and be deliveredbroadly over the area outlined. In one embodiment, the energy is focusedwithin an area having a diameter between about 200 μm and 5 mm as it isdelivered.

The location on the surface to which the energy is directed iscontrolled by an energy source direction modulator which is capable ofmoving the location on the surface where energy is applied. In additionto being coupled to the energy source, the energy source directionmodulator is also coupled to the outlining mechanism through thecontroller so that the energy source direction modulator directs energywithin the area outlined. As a result, changing the size and/or shape ofthe area outlined also serves to change the size and/or shape of thearea treated with energy.

The energy source direction modulator may be designed to direct energyover a desired pattern within the outlined area. For example, in oneembodiment, the energy source and energy source direction modulator maydirect energy over substantially all of the outlined area. For example,as illustrated in FIG. 5, energy may be rastered over area 24 (energytreated surface 29) with energy being continuously provided so thatenergy is substantially uniformly distributed over the area 24 of thesurface 20 being treated. Alternatively, as illustrated in FIG. 6,energy may be delivered in a desired pattern within the outlined area 24(energy treated surface 29).

When laser energy is used as the energy source, the energy sourcedirection modulator may be attached to the handpiece or in some cases,to a flexible wave guide if the laser utilizes one. Laser energy entersthe energy source direction modulator through an entry aperture.

Galvanometric motors may be used in the energy source directionmodulator to move the energy source within the outlined area. Thegalvanometric motors are preferably free-floating and are preferablyoperated under feedback control by the controller. In one embodiment,two orthogonally mounted galvanometric motors are resident in theoptical path inside the energy source direction modulator. Each motorhas a mirror, with wavelength specific coatings, permanently mounted onthe end of the motor shaft at a 45 degree angle with respect to an entryaperture. As the motor rotates the first axis mirror about the shaft,the energy is reflected to the other axis mirror, which reflects theenergy thru an output aperture, creating a 2 dimensional image. By usingthe two motors in this manner, virtually any 2 dimensional shape can beimaged on a surface.

Due to the wide angle of travel provided by the galvanometric motors, alarge outlined area can be treated with energy. The bandwidthcapabilities of the galvanometric motors and control circuits alsoprovide a wider range of pulsed laser repetition rates. While previousdevices have had a maximum scan frequency of 200 Hz, the system of thepresent invention can have scan frequencies of up to 4 kHz.

In one embodiment, energy is delivered continuously to the surface asthe energy source direction modulator adjusts the position of energydelivery. Alternatively, energy can be delivered non-continuously to thesurface, for example in a pulsed pattern.

For a pulsed laser emission, the coordination of the energy pulses isperformed on a timing baseline. During an energy pulse, the energydirection modulator keeps the energy focused on a single location withinthe area. Then, between energy pulses, the energy direction modulatorredirects the energy so that energy is delivered to the next desiredlocation. Since the duration of each pulse and the time between pulsesare each generally constant, movement of the energy source by thescanner from point to point is generally performed on a fixed timebasis. In addition, the time required for the energy direction modulatorto direct the energy to the next desired location is generally smallrelative to the time between pulses. As a result, the energy directionmodulator spends most of its time keeping the energy focused on a givenlocation.

After energy has been delivered over a desired area of the surface, thedelivery of energy is discontinued. Meanwhile, the outlining mechanismcontinues to produce an outline.

Illustrated in FIGS. 7A-7B is a method for performing dermoablationaccording to the present invention. As illustrated in FIG. 7A, an area42 is outlined on a patient's skin 44. As illustrated in FIG. 7B, thearea of skin 42 outlined in FIG. 7A is ablated with a laser. Area 46corresponds to ablated skin. The procedure illustrated in FIGS. 7A and7B may be repeated numerous times in order to ablate large areas of theskin. When repeating the steps illustrated in FIGS. 7A and 7B, it isgenerally preferred to outline and ablate areas adjacent to previouslyablated area in order to form an ablation pattern over a larger area.

When ablating areas of skin which are larger than the outlined area, itis also generally preferred that the outlined area have a shape which iscapable of forming a continuous mosaic of energy treated areas when aplurality of those shapes are laid next to each other. For example, apatient's skin can be ablated repeated times according to the stepsillustrated by FIGS. 7A and 7B such that a continuous mosaic of adjacentenergy treated areas is formed. The continuous mosaic is extended byoutlining an area adjacent the energy treated areas and then ablatingthe adjacent area.

When the apparatus and method of the present invention are used toablate an area of skin, the energy must be of a sufficient intensity toablate the skin. However, the energy should also be selected so that itdoes not ablate tissue too far beneath the surface of the skin,generally about 0.03 mm-0.05 mm. Parameters which influence the depth ofpenetration include the pulse energy, pulse duration, size of the energypulse on the skin, and the nature of the tissue being treated.

Illustrated in FIGS. 8A-D is a method for removing hair according to thepresent invention. As illustrated in FIG. 8A, an area of skin 52containing hair follicles 54 is outlined. As illustrated in FIG. 8B, thearea of skin 52 outlined in FIG. 8A is ablated with a laser. Areas 56corresponds to ablated skin. The procedure illustrated in FIGS. 8A and8B may be repeated numerous times in order to remove hair from largeareas of skin. When repeating the steps illustrated in FIGS. 8A and 8B,it is generally preferred to outline and treat areas adjacent topreviously treated areas. It is also generally preferred that theoutlined area have a shape which is capable of forming a continuousmosaic of energy treated areas when a plurality of those shapes are laidnext to each other. FIG. 8C illustrates skin which has been treatedrepeated times according to the steps illustrated by FIGS. 8A and 8B. Asillustrated in FIG. 8C, a continuous mosaic 58 of adjacent energytreated areas 56 have been formed. Also illustrated in FIG. 8C is thestep of outlining an area 60 adjacent the energy treated areas 56. FIG.8D illustrates the step of extending the continuous mosaic of adjacentenergy treated areas by ablating the area 60 outlined in FIG. 8C.

Illustrated in FIGS. 9A-E is a method for implanting hair according tothe present invention. As illustrated in FIG. 9A, an area of skin 62 isoutlined. As illustrated in FIG. 9B, the area of skin 62 outlined inFIG. 9A is ablated with a laser to form a series of craters into whichhair follicles are implanted. Each crater should preferably be formedwhere the center is deeper than the edges. Areas 66 corresponds toablated skin. As illustrated in FIG. 9C, hair follicles 68 are implantedinto the ablated areas 66.

The procedure illustrated in FIGS. 9A-9C may be repeated numerous timesin order to implant hair into large areas of skin. When repeating thesteps illustrated in FIGS. 9A-9C, it is generally preferred to outlineand treat areas adjacent to previously treated areas. It is alsogenerally preferred that the outlined area have a shape which is capableof forming a continuous mosaic of energy treated areas when a pluralityof those shapes are laid next to each other. FIG. 9D illustrates skinwhich has been treated repeated times according to the steps illustratedby FIGS. 9A-9C. As illustrated in FIG. 9D, a continuous mosaic 70 ofadjacent energy treated areas 66 have been formed. Also illustrated inFIG. 9D is step of outlining an area 72 adjacent the energy treatedareas 66. FIG. 9E illustrates the step of extending the continuousmosaic of adjacent energy treated areas by ablating the area 72 outlinedin FIG. 9D.

FIG. 10 illustrates one embodiment of an apparatus according to theinvention in which an Rf electrode 73 is used as the energy source. Asillustrated in the figure, the apparatus includes a light source 14 forproducing an aiming beam 16, an outlining mechanism 18 for moving theaiming beam 16 relative to a surface 22 to form a visually continuousoutline 20 around an area 24 of the surface 22, an Rf electrode 73 fordelivering Rf energy to the surface 22 within the outlined area 24, andan energy source direction modulator 71 which moves the Rf electroderelative to the skin to deliver Rf energy within the area 24 outlined onthe surface 22.

The foregoing description of a preferred embodiment of the invention hasbeen presented for purposes of illustration and description. It is notintended to be exhaustive or to limit the invention to the precise formsdisclosed. Obviously, many modifications and variations will be apparentto practitioners skilled in this art. It is intended that the scope ofthe invention be defined by the following claims and their equivalents.

What is claimed is:
 1. An apparatus for delivering energy to a selectedarea on a surface comprising:a handpiece by which the apparatus can beheld and moved relative to the surface, the handpiece having a distalend adjacent to which an aiming beam is focused; an outlining mechanismwhich receives light from a light source and directs an aiming beam to asurface; an energy source direction modulator which receives energy froman energy source and directs the energy to the surface; and a controllerwhich causes the outlining mechanism to move the aiming beam relative tothe surface to form a visually continuous outline around an area of thesurface and causes the energy source direction modulator to deliverenergy within the area formed by the visually continuous outline.
 2. Theapparatus according to claim 1, wherein the outlining mechanism producesvisually continuous outlines having a plurality of predetermined shapes.3. The apparatus according to claim 2, wherein the plurality ofpredetermined shapes include shapes selected from the group consistingof polygons, circles and ellipses.
 4. The apparatus according to claim2, wherein the shapes of the visually continuous outline include shapesselected from the group consisting of square, diamond, rectangle,triangle, pentagon, hexagon, heptagon, and octagon.
 5. The apparatusaccording to claim 1, wherein the outlining mechanism produces visuallycontinuous outlines having at least three different shapes.
 6. Theapparatus according to claim 1, wherein the apparatus includes an inputmechanism operatively connected to the controller by which an operatorcan program a shape of the visually continuous outline.
 7. The apparatusaccording to claim 1, wherein the outlining mechanism produces visuallycontinuous outlines having a shape and a plurality of sizes for theshape.
 8. The apparatus according to claim 1, wherein the outliningmechanism produces visually continuous outlines having a shape and aplurality of predetermined sizes for the shape.
 9. The apparatusaccording to claim 1, wherein the outlining mechanism produces visuallycontinuous outlines having a shape and a size which is fully adjustablewithin a size range.
 10. The apparatus according to claim 1, wherein thearea within the visually continuous outline is between about 9 mm² and2500 mm².
 11. The apparatus according to claim 1, wherein the controlleris programmable with regard to the size of the visually continuousoutline.
 12. The apparatus according to claim 1, wherein the outliningmechanism is adapted to receive light from a laser light source.
 13. Theapparatus according to claim 1, wherein the apparatus further includes alight source which includes a mechanism for adjusting the diameter ofthe aiming beam.
 14. The apparatus according to claim 1, wherein theapparatus is adapted to use light from the light source as energy fromthe energy source.
 15. The apparatus according to claim 1, wherein theenergy source direction modulator is adapted to deliver electromagneticenergy.
 16. The apparatus according to claim 1, wherein the energysource direction modulator is adapted to deliver energy of a formselected from the group consisting of visible light, ultraviolet light,RF energy, microwaves and ultrasonic energy.
 17. The apparatus accordingto claim 1, wherein the energy source direction modulator is adapted todeliver coherent light.
 18. The apparatus according to claim 17, whereinthe controller causes the energy source direction modulator to focus thecoherent light on a spot having a diameter less than 5 mm.
 19. Theapparatus according to claim 17, wherein the controller causes theenergy source direction modulator to focus the coherent light on a spothaving a diameter between about 200 μm and 5 mm.
 20. The apparatusaccording to claim 17, wherein the energy source direction modulator isadapted to deliver more than one wavelength of coherent light.
 21. Theapparatus according to claim 1, wherein the energy source directionmodulator is adapted to deliver laser light.
 22. The apparatus accordingto claim 1, wherein the controller directs energy over substantially allof the outlined area.
 23. The apparatus according to claim 1, whereinthe controller causes the energy source direction modulator tocontinuously deliver energy to the outlined area.
 24. The apparatusaccording to claim 1, wherein the energy source direction modulatordirects energy in a selected pattern within the outlined area andintermittently delivers energy as the energy source direction modulatormoves the location to which energy is delivered within the outlinedarea.
 25. The apparatus according to claim 1, wherein the controllercontrols the pattern by which energy is delivered within the outlinedarea.
 26. The apparatus according to claim 1, wherein the controllerincludes a feedback system for controlling the outlining mechanism andenergy source direction modulator.
 27. The apparatus according to claim26, wherein the controller disables the delivery of energy when an errorin an operation of the outlining mechanism or energy source directionmodulator is detected by the feedback system.
 28. The apparatusaccording to claim 26, wherein the controller produces an error signalwhen an error in an operation of the outlining mechanism or energysource direction modulator is detected by the feedback system.
 29. Theapparatus according to claim 26, wherein the controller includessoftware for controlling the size, shape and placement of the aimingbeam and energy, the software being stored as RAM data and as ROM data,the controller comparing the RAM data to the ROM data prior to operationand disabling the delivery of energy if the RAM data does not match theROM data.
 30. The apparatus according to claim 26, wherein thecontroller monitors an amount of power delivered to the apparatus anddisables the delivery of energy when the amount of power delivered tothe apparatus falls below a predetermined level.
 31. The apparatusaccording to claim 1, wherein the outlining mechanism includesgalvanometric motors for directing the aiming beam to form thecontinuous outline.
 32. The apparatus according to claim 1, wherein theoutlining mechanism scans at a scan frequency greater than 200 Hz. 33.The apparatus according to claim 1, wherein the outlining mechanismscans at a scan frequency between 200 Hz and 4 kHz.
 34. The apparatusaccording to claim 1, wherein the controller is programmed to causeenergy to be directed to the surface in a pattern adapted for performingdermoablation.
 35. The apparatus according to claim 1, wherein thecontroller is programmed to cause energy to be directed to the surfacein a pattern adapted for removing hair from an area of skin.
 36. Theapparatus according to claim 1, wherein the controller is programmed tocause energy to be directed to the surface in a pattern adapted tocreate holes in skin into which hair follicles can be implanted.
 37. Anapparatus for delivering energy to a selected area on a surfacecomprising:a handpiece by which the apparatus can be held and movedrelative to the surface, the handpiece having a distal end adjacent towhich an aiming beam is focused; an outlining mechanism which receiveslight from a light source and directs an aiming beam to a surface; anenergy source direction modulator which receives energy from an energysource and directs the energy to the surface; a controller which causesthe outlining mechanism to move the aiming beam relative to the surfaceto form a visually continuous outline around an area of the surface andcauses the energy source direction modulator to deliver energy withinthe area formed by the visually continuous outline; and an operatorselectable activation mechanism operatively connected to the controllerfor activating the energy source, the apparatus requiring continuousactivation of the activation mechanism in order to deliver energy. 38.The apparatus according to claim 37, wherein the operator selectableactivation mechanism is a footswitch.
 39. The apparatus according toclaim 37, wherein the operator selectable activation mechanism isconnected in series between the energy source and the controller.
 40. Ahand held dermoablation apparatus comprising:a handpiece portion bywhich the apparatus can be held and moved relative to a surface of apatient's skin; a distal end portion for resting the apparatus againstthe patient's skin; an outlining mechanism which receives light from alight source and directs an aiming beam to the patient's skin in theform of a visually continuous outline around an area of the patient'sskin; and an energy source direction modulator which receives energyfrom an energy source and directs the energy to the patient's skinwithin the area formed by the visually continuous outline.
 41. Theapparatus according to claim 40, wherein the controller is programmed tocause energy to be directed to the surface in a pattern adapted forperforming dermoablation.
 42. The apparatus according to claim 40,wherein the controller is programmed to cause energy to be directed tothe surface in a pattern adapted for removing hair from an area of skin.43. The apparatus according to claim 40, wherein the controller isprogrammed to cause energy to be directed to the surface in a patternadapted to create holes in skin into which hair follicles can beimplanted.